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25 Apr 15
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general lack of consensus in the diagnosis and treatment of DID[3]
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Even highly experienced therapists have few patients that achieve a unified identity
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cognitive behavioral therapy (CBT),[19] insight-oriented therapies,[17] dialectical behavioral therapy (DBT), hypnotherapy and eye movement desensitization and reprocessing (EMDR).
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Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established
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treatment generally lasts years—not weeks or months.
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There is debate over issues such as whether exposure therapy (reliving traumatic memories, also known as abreaction), engagement with alters and physical contact during therapy is appropriate and there are clinical opinions both for and against each option with little high-quality evidence for any position.
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"trauma-based cognitive therapy" to reduce cognitive distortions related to traum
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The first phase of therapy focuses on symptoms and relieving the distressing aspects of the condition, ensuring the safety of the individual, improving the patient's capacity to form and maintain healthy relationships, and improving general daily life functioning
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The second phase focuses on stepwise exposure to traumatic memories and prevention of re-dissociation
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reconnecting the identities of disparate alters into a single functioning identity with all its memories and experiences intact
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DID is a controversial diagnosis and condition, with much of the literature on DID still being generated and published in North America, to the extent that it was once regarded as a phenomenon confined to that continent
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16 Oct 14
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05 Sep 14
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08 May 14
parker batesDID a personality disorder often questioned in the 1960's as little was known.
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30 Apr 14
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Dissociative identity disorder
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mental disorder on the dissociative spectrum characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness
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Diagnosis is often difficult
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no clear consensus regarding its diagnosis or treatment.
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symptoms
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common lapses in attention
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becoming distracted by something else,
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aydreaming
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Symptoms are said to vary over time
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Causes
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iatrogenically by inappropriate psychotherapeutic techniques that cause a patient to enact the role of a patient with DID
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trauma
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memory processing that allows for the possibility that trauma-causing dissociation can occur after childhood in DID
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severe physical and sexual abuse, especially during early to mid-childhood
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02 Apr 14
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Malingering should be considered if there is possible financial or forensic gain, as well as factitious disorder if help-seeking behavior is prominent.
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DID i
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23 Jan 14
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22 Nov 13
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is an extremely rare mental disorder characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness.
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13 Aug 13
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DID is one of the most controversial psychiatric disorders with no clear consensus regarding its diagnosis or treatment.[3] Research on treatment effectiveness still focuses mainly on clinical approaches and case studies. Dissociative symptoms range from common lapses in attention, becoming distracted by something else, and daydreaming, to pathological dissociative disorders.[4] No systematic, empirically-supported definition of "dissociation" exists.[5][6]
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Disturbed and altered sleep has also been suggested as having a role in dissociative disorders in general and specifically in DID
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09 Aug 13
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15 Apr 13
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Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD),[1][2] is a mental disorder characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness
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DID ), previously known as multiple personality disorder ( MPD ), [1] [2] is a mental disorder characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness .
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Therapy for DID is generally phase oriented. Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment — though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient.
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10 Apr 13
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lacks a precise, empirical and generally agreed upon definition
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Identities may be unaware of each other and compartmentalize knowledge and memories
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Co-morbid disorders can include substance abuse, eating disorders, anxiety, posttraumatic stress disorder (PTSD) and personality disorders.[24]
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Even using strict diagnostic criteria, it can be difficult to distinguish between dissociative disorders and BPD (as well as bipolar disorder and schizophrenia).
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The DSM states that acts of self-mutilation, impulsivity and rapid changes in interpersonal relationships "may warrant a concurrent diagnosis of Borderline Personality Disorder"
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have experienced severe physical and sexual abuse, especially during early to mid-childhood,
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They also report more historical psychological trauma than those diagnosed with any other mental illness
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Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral (CBT),[18] insight-oriented therapies,[16] dialectical behavioral therapy (DBT), hypnotherapy and eye movement desensitization and reprocessing (EMDR). Medications can be used for co-morbid disorders and/or targeted symptom relief.[10][37] Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established.[54
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Regular contact (weekly or biweekly) is more common, and treatment generally lasts years — not weeks or months.[10][18] Sleep hygiene has been suggested as a treatment option, but has not been tested.
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01 Feb 13
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Causes
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13 Jan 13
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Finally, individuals diagnosed with DID who are accused of crimes may deny culpability due to the crime being committed by a different identity state.
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In cases where not guilty by reason of insanity (NGRI) is used as a defence in a court, it is normally accompanied by one of three legal approaches — claiming a specific alter was in control when the crime was committed (and if that alter is considered insane), deciding whether all (or which) alters may be insane, or whether only the dominant personality meets the insanity standard.[58] NGRI is rarely successful for individuals with DID accused of committing crimes while in a dissociated states
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22 Dec 12
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19 Sep 12
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05 Jun 12
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The diagnosis requires that at least two personalities (one may be the host) routinely take control of the individual's behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be the temporary effects of drug use or a general medical condition.
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26 Feb 12
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22 Jan 12
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10 Jul 11
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25 Apr 11
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This disorder is theoretically linked with the interaction of overwhelming stress, traumatic antecedents,[32] insufficient childhood nurturing, and an innate ability to dissociate memories or experiences from consciousness.[11] A high percentage of patients report child abuse.[7][33] People diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially during early to mid childhood.[34] Several psychiatric rating scales of DID sufferers suggested that DID is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.[
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31 Mar 11
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16 Nov 10
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02 Sep 10
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18 Apr 10
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15 Dec 09
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28 Oct 09
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The diagnosis requires that at least two personalities routinely take control of the individual's behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be due to drug use or medical condition
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demonstrate a variety of symptoms with wide fluctuations across time; functioning can vary from severe impairment in daily functioning to normal or high abilities.
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DID does not resolve spontaneously, and symptoms vary over time. Individuals with primarily dissociative symptoms and features of posttraumatic stress disorder normally recover with treatment. Those with comorbid addictions, personality, mood, or eating disorders face a longer, slower, and more complicated recovery process. Individuals still attached to abusers face the poorest prognosis; treatment may be long-term and consist solely of symptom relief rather than personality integration. Changes in identity, loss of memory, and awaking in unexplained locations and situations often leads to chaotic personal lives.[1]
Individuals with the condition commonly attempt suicide
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16 May 09
my serendipitiesDissociative identity disorder (DID), as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), is a psychiatric diagnosis that describes a condition in which a single person displays multiple distin
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27 Feb 09
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18 Sep 07
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The diagnosis requires that at least two personalities routinely take control of the individual's behavior and that there is associated memory loss that goes beyond normal forgetfulness, often referred to as losing time or acute Dissociative Amnesia[1]
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As a diagnosis, DID remains controversial. For many years DID was regarded as a North American phenomenon[3][4][5] with the bulk of the literature still arising there. However, research demonstrates a lack of consensus belief in the validity of DID amongst North American psychiatrists.[6][7] Practitioners who do accept DID as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America. Criticism of the diagnosis continues with Piper and Merskey describing it as a culture bound and often iatrogenic condition which they believe is in decline.[5][8]
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Dissociation is recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and Borderline Personality Disorder[14]. Often regarded as a dynamic sub-symptomatology, it has become more frequent as an ancillary diagnosis, rather than a primary diagnosis.[citation needed]
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- The result of therapist suggestions to suggestible people, much as Charcot's hysterics acted in accordance with his expectations.
- Psychiatrists' past failure to recognise dissociation being redressed by new training and knowledge.
- Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria."
- Powerful psychosocial forces are changing the psychological balance of individuals so as to make dissociative experiences more common.
The MPD/DID epidemic in North America
Paris[15] in a review offered four possible causes for the sudden increase in people diagnosed with MPD/DID:
Paris opines that the first possible cause is the most likely.
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Unlike other diagnostic categorizations, there is very little in the way of objective, quantifiable evidence for describing the disorder. This makes the disorder itself subjective, as well as its diagnosis.
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- Whether MPD/DID is a real disorder or just a fad.
- If it is real, is the appearance of multiple personalities real or delusional.
- If it is real, whether it should it be defined in psychoanalytic terms.
- Whether it can, or should, be cured.
- Who should primarily define the experience—therapists, or those who believe that they have multiple personalities.
The main points of disagreement are these:
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Although many experts dispute the existence of this controversial diagnosis, Dissociative Identity Disorder has been attributed by some to the interaction of several factors: overwhelming stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiences[17]
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History
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In 1910 Bleuler introduced the term "schizophrenia" to replace "dementia praecox" and a review of the Index Medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia "caught on," especially in the United States.[65]
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As media coverage spiked, diagnoses climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990.[66] Acocella reports that 40,000 cases were diagnosed from 1985 to 1995.[67] The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally[68] with reports recently emerging from other countries.[50][51][52][53][54][57][58]
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18 May 07
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